<div  class="content">
    <div class="grid_container">
        <div class="grid_12">
            <div class="widget_wrap" style="height: 500px;">
                <div class="widget_top">
                    <span class="h_icon list"></span>
                    <h6>Form Elements</h6>
                </div>
                <div class="widget_content">
                    <form action="<?php echo $this->Html->url(array('controller'=>'paneles', 'action'=>'admin'))?>" method="post" id="regitstraion_form" class="form_container left_label">
                        <ul>
                            <li>
                                <div class="form_grid_12">
                                    <label class="field_title">Seleccione la patologia <span class="label_intro">sintomas del paciente</span></label>
                                    <div class="form_input">
                                        <select id="combo" data-placeholder="Your Favorite Football Team" style=" width:300px" class="chzn-select" tabindex="13">
                                            <option value=""></option>
                                            <optgroup label="MUSCULAR">
                                                <option>TRAUMA  DE CRANEO</option>
                                                <option>TRAUMA  TORACICO</option>
                                                <option>TRAUMA  ADDOMINALE/PELVICO</option>
                                                <option>TRAUMA  VERTEBRAL</option>
                                            </optgroup>
                                            <optgroup label="VENTRICULAR">
                                                <option>TRAUMA  DE ERNEA</option>
                                                <option>TRAUMA  VASO</option>
                                                <option>TRAUMA  ARTERIA</option>
                                                <option>TRAUMA  CORAZON</option>
                                            </optgroup>
                                        </select>
                                    </div>
                                </div>
                            </li>
                           
                            <li>
                                <div class="form_grid_12">
                                    <div class="form_input">

                                        <label class="field_title" for="agree">SINTOMAS</label>
                                        <input type="hiden"/>
                                    </div>
                                </div>
                            </li>
                            <div id="carga">
                                <li>
                                <div class="form_grid_12">
                                    <label class="field_title">Signo  de   compromiso de via  aerea</label>
                                    <div class="form_input">
                                        <span>
                                            <input name="field08" class="checkbox" type="checkbox" value="First" tabindex="7">
                                            <label class="choice">ROJO</label>
                                        </span>
                                    </div>
                                </div>
                            </li>
                            <li>
                                <div class="form_grid_12">
                                    <label class="field_title">rinorrafia, otorrafia, rinorrea, otorrea (LCR) </label>
                                    <div class="form_input">
                                        <span>
                                            <input name="field08" class="checkbox" type="checkbox" value="First" tabindex="7">
                                            <label class="choice">ROJO</label>
                                        </span>
                                    </div>
                                </div>
                            </li>
                            <li>
                                <div class="form_grid_12">
                                    <label class="field_title">signo de fraCtcura base craneo(signo del mapache, signo de Batter)</label>
                                    <div class="form_input">
                                        <span>
                                            <input name="field08" class="checkbox" type="checkbox" value="First" tabindex="7">
                                            <label class="choice">ROJO</label>
                                        </span>
                                    </div>
                                </div>
                            </li>
                            </div>
                            
                            <li>
                                <div class="form_grid_12">
                                    <div class="form_input">
                                        <button type="submit" class="btn_small btn_blue"><span>Registrar</span></button>
                                        <button type="reset" class="btn_small btn_blue" id="boton_cerrar"><span>Limpiar</span></button>
                                    </div>
                                </div>
                            </li>
                        </ul>
                    </form>
                    <div class="clear">
                        
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>
<script>
   $(document).ready(function(){
       $("#carga").hide();
       $("#combo").change(function(){
           $("#carga").toggle('slow');
       });
       $("#boton_cerrar").click(function(){
           $("#carga").toggle('slow',null, 'hide')
       });
   });
</script>
